[Various types of vertigo and balance disorders in patients with Meniere's disease]. / Razlichnye formy golovokruzheniya i narusheniya ravnovesiya pri bolezni Men'era.

Vertigo and balance disorders in Meniere's disease (MD) may have various etiology. The aim of the review is discussing pathogenetic mechanisms of the typical vertiginous paroxysms in MD, resulting from endolymphatic hydrops as well as analysis of etiology, pathogenesis, clinical course and basic treatment of paroxysmal and permanent forms of vertigo and balance disorders, caused by other conditions, associated with MD. We discussed the course of MD complicated by vestibular migraine, benign positional paroxysmal vertigo, functional dizziness, bilateral vestibulopathy and vestibular drop-attacks.

[Vascular mechanisms in Meniere's disease]. / Sosudistye mekhanizmy v razvitii bolezni Men'era.

Meniere's disease (MD) is chronic multifactorial medical condition caused by endolymphatic hydrops, which etiology is unclear. This review highlights possible vascular mechanisms of MD. Impairment of vascular regulation, further ischemic damage of labyrinth and venous drainage pathology could lead to endolymphatic hydrops. Epidemiologic studies reveal high comorbidity of MD and migraine. Both diseases could be the result of trigeminovascular dysfunction. Betahistine, the medication with vascular effect, is widely used in treatment of MD, the effectiveness of calcium channel blockers is evaluated. Keywords: vertigo, Meniere's disease, endolymphatichydrops, migraine, vascular mechanisms, betahistine.

[Early diagnosing of delirium in the elderly with acute stroke].

Delirium is a common complication of stroke worsening its prognosis. The aim of the work is to identify the group of risk for the development of delirium among elderly patients with acute stroke and assessment of diagnostic value of 4-A test in identifying delirium in this category of patients. We included 73 patients in the study, 33 (45 %) of which had symptoms of delirium according to DSM-IV. Patients with delirium had more severe neurological deficit, more prominent chronic changes on brain CT, more often had positive axial reflexes, had higher erythrocyte sedimentation rate. All patients with pneumonia were delirious. Russian version of 4-A test showed good psychometric properties. Thus the risk of the development of delirium in older adults with acute stroke is higher among patients with severe strokes, more prominent chronic changes in the brain according to CT and clinical examination and in those with inflammatory complications. Purposeful screening of the patients with aforementioned risk factors with instruments such as 4-AT will allow more efficient and fast diagnosing of delirium on early stages in the elderly with acute stroke.

[The early post-stroke mobilization].

Early mobilization is an important prerequisite for the successful recovery after stroke. However, it is unclear at present how early mobilization should be started after stroke. Three randomized controlled trials were devoted to the comparison of the effectiveness and safety of very early (within the first day after stroke) and early (within two days after stroke) mobilization. The meta-analysis of the results of these studies did not reveal any advantages of very early mobilization over early mobilization. One randomized control study was designed to compare the consequences of mobilization within 3 and 7 days after stroke. It has demonstrated that earlier mobilization is associated with fewer complications and does not exert negative effect on cerebral haemodynamics. A number of observational studies confirmed the positive effect of early mobilization on the outcome of stroke. It is concluded that it may be justified to start mobilization on the second day after stroke provided there are no contraindications to such modality. The practicability of very early mobilization remains to be elucidated.

[Detection of cognitive deficit in a therapist's practice: review of screening scales].

Acute and chronic cognitive impairments quite often complicate visceral diseases. In this connection, it is important for a therapist to know brief scales to screen for cognitive impairments. Tests, such as a six-component screener, a short orientation-memory-concentration test, a short portable mental status questionnaire, Hodkinson's abbreviated mental test (AMT) (AMT-4 and AMT-10), a clock drawing test, and 4 'A's Test (4AT) may be used for the primary assessment of cognitive functions. Mini-Mental Status Examination may be further used if dementia is suspected; the Montreal Cognitive Assessment may be applied to identify moderate cognitive impairments. Special scales, such as the confusion assessment method for the intensive care unit, are employed to diagnose acute cognitive dysfunction.

[Delirium in the clinical practice of a therapist].

Delirium is a neuropsychiatric condition that may complicate any visceral disease. Its rate is especially high among patients with inflammatory diseases or metabolic disturbances and in the elderly. Brain injury concurrent with an abnormal stress response underlies the development of delirium. The clinical picture of delirium is characterized by clouding of consciousness accompanied by global cognitive and behavioral changes. According to the nature of changes in motor behavior, delirium is divided into hyperactive, hypoactive, and mixed subtypes. Special scales, such as Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), are used to identify delirium. Management of delirium includes specific therapy for the underlying disease and adequate care. Low-dose neuroleptics, haloperidol in particular, are recommended to correct behavioral changes.

[Infectious-inflammatory complications of cerebral insulitis].

Pneumonia and urinary tract infections develop in roughly 1/3 of the survivors of cerebral stroke. Post-stroke pneumonia results from aspiration and uroinfection from neurogenic disturbances of urination and bladder catheterization. Post-stroke immune deficiency increases the risk of infectious and inflammatory complications. These conditions are treated in accordance with the general principles of management of these diseases. Prophylaxis of pneumonia is reduced to the principle of "nothing orally" before the swallowing capacity is tested, early mobilization, and oral cavity hygiene. Studies on the role of prophylactic antibiotic therapy and ACE inhibitors in the prevention of post-stroke pneumonia are currently underway. Bladder catheterization under strict indications and the use ofcatheters coated with antibacterial agents or condom urine bags in men are likely to reduce the risk of uroinfection. Infectious and inflammatory complications impair the outcome of stroke. Their prophylaxis and adequate treatment are prerequisites of successful recovery after stroke.

[Promising approaches to the pathogenetic therapy of amyotrophic lateral sclerosis]. / Perspektivnye podkhody k patogeneticheskoi terapii bokovogo amiotroficheskogo skleroza.

Amyotrophic lateral sclerosis is a severe incurable disease of the nervous system. Currently only methods of palliative care for the patients with this disease are available. Few medications for the pathogenetic therapy are registered in some countries, i.e. riluzole, edaravon, sodium phenylbutyrate/taurursodiol as well as tofersen (conditionally). Their efficacy is relatively low. The main directions in the development of pathogenetic therapy of ALS include gene therapy, use of stem cells, immunomodulators, agents affecting gut microbiota. A search is also underway for low-molecular compounds with neuroprotective and antioxidant properties. Perspective direction is prevention of ALS. This will be possible when biomarkers for identification of patients in pre-manifest/prodromal stage are detected.

[The impact of the impairment of social cognitive functions in acute stage of stroke on its functional outcomes]. / Vliyanie narushenii sotsial'nykh kognitivnykh funktsii v ostrom periode ishemicheskogo insul'ta na ego funktsional'nye iskhody.

OBJECTIVE: To analyze the influence of the impairment of social cognitive functions (SCF) in acute phase of ischemic stroke (IS) on its functional outcomes in 6 months. MATERIAL AND METHODS: One hundred patients with IS were included in the study. The assessment of social-demographic, clinical characteristics and SCF (theory of mind (ToM), affective empathy, social empathy) of the patients on the day 10 after stroke was conducted. Patients underwent standard laboratory tests of blood and urine. Functional outcomes in 6 months were recorded; score ≥3 on the modified Rankin scale (mRs) indicated unfavorable outcome. Multiple linear regression analysis was performed to identify independent predictors of functional outcomes of stroke in 6 months. RESULTS: Patients with unfavorable outcomes in 6 months after stroke in acute phase had more severe neurological deficit, more prominent disability level, lower mobility, severer impairment of SCF and lower level of total protein in biochemical analysis of blood. The independent predictors of functional outcomes of IS in 6 months included severity of the impairment of SCF (namely, ToM) according to the Reading the Mind in the Eyes test and severity of functional impairment on admission assessed by mRs. CONCLUSION: Changes of SCF, particularly of ToM, in the acute phase of IS are associated with its unfavorable functional outcomes in 6 months.

[CT-predictors of unfavorable outcome in hemorrhagic stroke]. / KT-prediktory neblagopriyatnogo iskhoda gemorragicheskogo insul'ta.

OBJECTIVE: To analyze the relationship between the changes on non-contrast CT of the head in patients with acute hemorrhagic stroke and its unfavorable outcome within 90 days. MATERIAL AND METHODS: The retrospective analysis of the clinical, demographic parameters and results of CT of the head of all patients admitted to the stroke unit of the district hospital between January 2015 and December 2021 was performed. The data of 131 patients were included in the work (52% males), average age was 65.75±14.1. RESULTS: Fatal outcomes were recorded in 13.7% of cases. The age of the patient, severity of neurological deficit and CT-signs predicting hematoma expansion were independent predictors of unfavorable outcomes of hemorrhagic stroke within 90 days. CONCLUSION: Detection of the sings predicting hematoma enlargement on CT scans improves prognostication of the outcomes of hemorrhagic stroke.

[A case of COVID-associated encephalopathy in a patient with multiple sclerosis]. / Klinicheskii sluchai COVID-assotsiirovannoi entsefalopatii u patsienta s rasseyannym sklerozom.

A case of acute encephalopathy manifested with impaired consciousness, hemichorrhea, speech and cognitive impairment in a female patient with COVID-19 and multiple sclerosis is presented. In the literature, there are isolated reports of such a combination of diseases, and therefore difficulties arise in carrying out differential diagnosis and prescribing therapy. Given the limited knowledge about the long-term consequences of COVID-19, systematic analysis of such cases and follow-up of such patients is necessary.

[Amyotrophic lateral sclerosis associated with a new pathogenic variant of the ERBB4 gene]. / Sluchai bokovogo amiotroficheskogo skleroza, svyazannogo s novoi mutatsiei v gene ERBB4.

Amyotrophic lateral sclerosis (ALS) is a sporadic disease in most of the cases; in 10-15% of cases genetic forms are recorded. A genetic form of ALS associated with the mutation in the ERBB4 gene (ALS19) has been reported in 2013. A protein encoded by the ERBB4 is probably involved in ubiquitous component of the pathogenesis of ALS. We present a case of ALS associated with a new pathogenic variant of the ERBB4 gene, with early bulbar onset and slow progression of the disease within 10 years.

[The influence of uric acid on the course of amyotrophic lateral sclerosis]. / Vliyanie mochevoi kisloty na techenie bokovogo amiotroficheskogo skleroza.

Uric acid has antioxidant and neuroprotective properties. A number of studies show that high levels of uric acid may have a positive influence on the course of amyotrophic lateral sclerosis (ALS), especially in males. The frequency of ALS is lower in patients with gout than in the general population. We present a case of a patient with gout and slowly progressive ALS. More research is needed on the potential role of uric acid in ALS and other neurodegenerative disorders.

[Emotional disorders after stroke]. / Emotsional'nye rasstroistva posle insul'ta.

Emotional disorders are common among patients after stroke. They include anger, fear, emotional expression control (uncontrollable crying, laughing), emotional indifference (apathy), disorders of emotion recognition and emotional empathy. They might develop independently or as a presentation of depression, anxiety, catastrophic reaction, posttraumatic stress disorder etc. Treatment of post-stroke emotional disorders include pharmacotherapy, psychotherapy, neuromodulation.

[Digital technologies in the assessment of neurological status]. / Tsifrovye tekhnologii v otsenke nevrologicheskogo statusa.

Digital technologies (DT) can be used at all stages of the neurologist's work with the patient. The medical professional can obtain online information on the patient's complaints and history. DT may help to assess cognitive functions, muscular power, details of the movements including gate. The methods of the assessment of sensory functions are being currently developed. The methods of the assessment of the olfaction, vision, oculomotor function, pupillary reactions, mimic muscles, hearing and balance are also developed, however the methods of assessment of the function of trigeminal nerve, movement of the head, neck and tongue using DT are not available. The assessment of the reflexes using DT is not developed yet. The use of DT is possible in telemedicine, in long-term monitoring of the neurological status of the patient, as well as in the clinical exam in order to obtain additional, more detailed data.

[A clinical case of multiple sclerosis with an episode of schizophrenia-like syndrome]. / Rasseyannyi skleroz s epizodom shizofrenopodobnogo sindroma.

The article presents a clinical observation of a schizophrenia-like disorder in a patient with multiple sclerosis (MS). The patient had highly active MS with a relapsing course, the diagnosis was made based on the McDonald 2017 criteria. During the course of a demyelinating disease of the nervous system, the patient developed an episode of psychotic disorders with symptoms of mutism, hallucinations, delusions and impaired thinking, which was quickly stopped in stationary conditions. This case is of particular interest to neurologists and psychiatrists, since psychotic disorders occur in MS patients and cause difficulties in diagnosis and treatment.

Biological correlates of post-stroke fatigue: a systematic review.

Fatigue is a common and disabling consequence of stroke. Its mechanisms are unknown. Neuroanatomical abnormalities (e.g. white matter lesions, brain atrophy), neuroendocrine dysregulation, neurotransmitter changes and inflammation are associated with fatigue in conditions other than stroke. This review sought to identify published studies describing associations between post-stroke fatigue and these biological factors. We searched Medline, EMBASE, CINAHL, PsycINFO and AMED on October 15 and PubMed on 28 December 2010 and included studies in English that recruited at least 10 patients (>18 years old) with stroke, assessed fatigue and reported its relationship with neuroanatomical abnormalities, hypothalamo-pituitary-adrenal axis dysregulation, neurotransmitter changes or inflammation. Of 4916 citations from the searches, 17 studies met our inclusion criteria. There was no association between white matter lesions, brain atrophy or pathological type of stroke and fatigue (seven studies, n = 4746). The data on relationship between lesion location and fatigue were inconclusive: four (n = 675) of 13 studies (n = 1613) showed associations between fatigue and infratentorial lesion location (brainstem in particular) or basal ganglia stroke. One study reported C-reactive protein levels and found an association with fatigue. No studies reported hypothalamo-pituitary-adrenal axis dysregulation or neurotransmitter changes and fatigue. We could not perform meta-analysis because the studies used different methods of fatigue assessment, examined different populations and had different designs. The biological mechanisms of post-stroke fatigue are uncertain. Further studies are required to determine the relationship between post-stroke fatigue and biological factors.

[An analysis of clinical and laboratory characteristics of patients with ischemic stroke and COVID-19]. / Analiz kliniko-laboratornykh kharakteristik patsientov s ishemicheskim insul'tom, assotsiirovannym s COVID-19.

OBJECTIVE: To analyze clinical and laboratory characteristics of patients with ischemic stroke associated with COVID-19. MATERIAL AND METHODS: A retrospective analysis of all cases of COVID-19, including those complicated with ischemic stroke, admitted to the multispecialty infectious hospital in Ufa (Russia) in 2020, was performed. Multivariate analysis was used to identify the independent predictors of the development of ischemic stroke in patients with COVID-19. RESULTS: Eleven thousand forty hundred and thirty-two patients were admitted to the multidisciplinary infectious hospital during 2020, 1226 of them also suffered from ischemic stroke. Independent predictors of ischemic stroke in COVID-19 included age and laboratory parameters: increase in number of leucocytes, erythrocytes and platelets, increase of the level of creatinine, glucose, total bilirubin and decrease of the level of total protein, and activated partial thromboplastin time. CONCLUSION: Elderly people, patients with prominent systemic inflammatory response, which presented with leukocytosis, hypercoagulation, multiorgan failure of different severity and hypoproteinemia, were at higher risk of the development of ischemic stroke in COVID-19.

[Neuropsychiatric presentations of amyotrophic lateral sclerosis]. / Neiropsikhiatricheskie proyavleniya bokovogo amiotroficheskogo skleroza.

Neuropsychiatric presentations are observed in a substantial number of patients with amyotrophic lateral sclerosis (ALS). Severe behavioral disorders develop in ALS combined with frontotemporal dementia, which are considered to be a disease continuum. Psychiatric disorders in ALS with predominantly motor symptoms are less prominent and mostly presented with apathy. Psychiatric disorders in ALS by their origin could be psychogenic, reflecting the patients' reactions on severe disease, and organic, developing as a result of degeneration of central motor neurons and disconnection between fronto-subcortical and frontotemporal loops. An important role in the development of psychiatric disorders in ALS belongs to genetic factors, in particular to hexanucleotide expansion in the C9orf72 gene. During the first months after establishing the diagnosis of ALS, there is the high risk of developing depressive disorders, which in severe cases can lead to suicide. More research is needed in this area.

[Clinical and laboratory predictors of unfavorable outcome in hemorrhagic stroke]. / Kliniko-laboratornye prediktory neblagopriyatnogo iskhoda gemorragicheskogo insul'ta.

OBJECTIVE: The study was to analyze the relationship laboratory parameters of the blood in acute phase of hemorrhagic stroke and its unfavorable outcomes within 90 days. MATERIAL AND METHODS: We performed retrospective analysis of 122 patients with hemorrhagic stroke from Dyurtyuli district hospital between 2015 and 2020. The laboratory parameters in patients with favorable and unfavorable outcomes were compared. Multivariate analysis was performed to identify the independent predictors of death after hemorrhagic stroke. RESULTS: Death within 90 days after hemorrhagic stroke was registered in 16 cases (13%). In this group of patients the count of RBC, lymphocytes, prothrombin index, hemoglobin level were lower, count of WBC, neutrophil-lymphocyte ratio (NLR) and INR were higher (p<0.05). Patients' age, stroke severity according to NIHSS, hemoglobin level, NLR were the independent predictors of death in patients with hemorrhagic stroke according to multivariate analysis. CONCLUSION: Standard laboratory analyses can predict the outcome of hemorrhagic stroke.